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  1. 1. Social Inequalities and Exercise during Adulthood: Toward an Ecological Perspective Author(s): Joseph G. Grzywacz and Nadine F. Marks Source: Journal of Health and Social Behavior, Vol. 42, No. 2 (Jun., 2001), pp. 202-220 Published by: American Sociological Association Stable URL: Accessed: 13/05/2009 19:06 Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission. JSTOR is a not-for-profit organization founded in 1995 to build trusted digital archives for scholarship. We work with the scholarly community to preserve their work and the materials they rely upon, and to build a common research platform that promotes the discovery and use of these resources. For more information about JSTOR, please contact American Sociological Association is collaborating with JSTOR to digitize, preserve and extend access to Journal of Health and Social Behavior.
  2. 2. Social Inequalities and Exercise during Adulthood: Toward an Ecological Perspective* JOSEPH G. GRZYWACZ Universityof NorthernIowa NADINE F. MARKS Universityof Wisconsin-Madison 2001,Vol42 (June): Journal Health SocialBehavior of 202-220 and Grounded in ecological theory, this study examines the association among par- ticipation in regular vigorous exercise and social status, aspects of prominent life settings, interactions between life settings, and more proximal individual resources and processes using data from the National Survey of Midlife Development in the United States (N = 3,032). Among women, a higher level of earnings was associated with more vigorous exercise, yet those women with more education had a steeper decline in exercise across adulthood. Among men, those with the lowest level of education had the steepest decline in physical activity across adulthood, and earnings did not affect exercise patterns. Less participation in vigorous exercise among blacks, in contrast to nonblacks, was explained by their tendency to live in less safe neighborhoods and having more functional health problems. Finally, contextual factors from multiple domains were independently associated with participation in regular exercise. Consistent with ecological theory, these results suggest that interventions to promote exercise habits among adults need to consider the independent and interactive effects of multiple contextualfactors. Regular physical activity has been demon- ic and acute morbidity (Breslow and Breslow strated to promote longevity (Berkman and 1993; U.S. Departmentof Health and Human Breslow 1983; Fried et al. 1998; Paffenbarger Services 1996), and facilitate higher levels of et al. 1994; U.S. Department of Health and psychological well-being throughout adult- Human Services 1996), reduce rates of chron- hood (Albert 1995; Fries and Crapo 1985; Folkins and Sime 1981; Rowe and Kahn 1987; Tkachukand Martin1999; U.S. Department of *Please address correspondence Joseph G. Health and Human Services 1996). Most to: Divisionof Health Schoolof adultsremaininactive despite widespreadpro- Promotion, Grzywacz, and Health,PhysicalEducation, LeisureServices, gramming to initiate regularphysical activity University of Northern Iowa, 203 Wellness/ Cedar Falls, IA 50614-0241. (Public Health Service 1991). National esti- Recreation Center, mates indicate that 30 percent of American This research was supportedby a National adults remain completely sedentary,and only Traineeship 14-23 percent of adults engage in enough Institute Mental of Health Post-Doctoral (MH19958), the National Institute on Aging physical activity to achieve health-related ben- the (AG12731), National Institute Mental of Health efits (Centers for Disease Control 1997; U.S. (MH61083),and the John D. and Catherine T. of Health and Human Services MacArthurFoundationResearch Network on Department 1996). Successful MidlifeDevelopment. significant A por- occurred Individuals in lower social status positions tion of the preparation this manuscript of while the lead author was affiliated with the participatein less physical activity than their of higher status counterparts. Older adults, of and Department Psychology SocialBehavior theUniversity California, of Irvine. women, blacks, and individuals of lower 202
  3. 3. AND 203 INEQUALITIESEXERCISE SOCIAL socioeconomic status are consistentlyfound to AND EMPIRICAL THEORETICAL BACKGROUND exercise less regularlyand are more likely to be completely sedentarythan younger adults, Ecological theory, as explicated by men, whites, and higher socioeconomic status Bronfenbrenner and colleagues (Bronfen- individuals (for reviews see Blair 1988; brenner1979; Bronfenbrenner Ceci 1994; and Centers for Disease Control 1997; Dishman Bronfenbrennerand Morris 1998), can serve 1991; King et al. 1992; U.S. Department of as a valuable tool for further understanding Health and Human Services 1996). Given this and modeling the determinants of positive evidence, age, gender, race, and educationare health behaviors (Fitzgerald et al. 1994; typically included as important covariates McLeroy et al. 1988; Sallis and Owen 1997; when developing and testing models of physi- Stokols 1996). Bronfenbrenner's model posits cal activity. However, inattentively quot;control- that behaviors such as physical activity are ling forquot; social status is a major limitation in influenced by a variety of factors from multi- health research (Marmot, Kogevinas, and ple ecological levels (e.g., individual, Elston 1987). Instead,Marmotand colleagues microsystemic, mesosystemic, and macrosys- (1987) as well as others (Krieger, Williams, temic) and change as a function of develop- and Moss 1997; Williams 1990) argue that mental and historical time. Consequently, more researchdirectlyexaminingthe effects of using an ecological perspective, scholars can integratea rich arrayof known determinants of social status on health-relatedphenomena is physical activity (for reviews see Blair 1988; critically needed since social status creates a Dishman 1991; King et al. 1992; U.S. broad context that shapes routine experiences Department of Health and Human Services that affect health-related behavior. 1996) into models of exercise to better specify In this study, we seek to expand our under- predictive models for different periods in the standing of physical activity patternsby con- life course. In addition to being more con- sidering exercise behavior within the broad ducive to a more comprehensive theory of context of social status, and examining how health behavior, an ecological approach also contextualfactors from prominentlife settings has severalpracticalbenefits. Most notably,an and more proximal individual resources and ecological approachattenuatesthe possibility processes help account for and uniquely con- of quot;victim-blamingquot;(e.g., Becker 1986) by tributeto differencesin exercise. Guidedby an drawing attention to additional targets for ecological perspective and previous research, intervention beyond the individual. When we theorize that the often-noted declines in acted upon and changed, these socio-environ- activity by age, and the frequentlycited differ- mental factors frequently bring about more ences in physical activity by gender,race, and sustainable change in individual and popula- tion health behavior(Green and Krueter1999; socioeconomic status do not act independently Stokols, Pelletier,and Fielding 1996). of each other.Thus, in this study we systemat- ically examine the independentand interactive effects of age, gender,andmultipledimensions Social Status and Physical Activity of socioeconomic status on physical activity patterns throughout adulthood. Consistent Severalpersonalcharacteristics representing with previousscholars,we furthertheorizethat individuals' relative location in status hierar- social status partially allocates contextual chies predict participationin regularphysical resources, opportunities, and barriers at the activity. Lower socioeconomic status, older individual,family,work,and communitylevels age, being female, and being black are consis- that may influence physical activity patterns. tently associatedwith less participationin reg- Therefore,we examine the independenteffects ular physical activity (for reviews see Blair of individual-level, family- and work-related, 1988; Dishman 1991; King et al. 1992; U.S. as well as community experiences on regular Department of Health and Human Services exercise, and we consider the extent to which 1996). Like previous scholars (Ross and Wu the effects of social status operate through 1995; Stronegger,Freidl, and Rasky 1997), we theorize that social location in status hierar- shaping differences in these everyday experi- chies is an importantconditioning factor for ences.
  4. 4. 204 JOURNALOF HEALTHAND SOCIALBEHAVIOR the allocation of resources, opportunities,and earnings on exercise habits will be more pro- constraintsthat influence behaviors related to nounced among men than women. health, such as exercise. Time is a centralconcept in ecological mod- Socioeconomic status is consistentlyassoci- els (Bronfenbrenner1995), and it draws our ated with health behaviorsand health behavior attentionto the enduringcontext of socioeco- change: Lower socioeconomic status individu- nomic status for the developmentand mainte- als participatein fewer positive health behav- nance of positive health behaviors such as iors (e.g., exercise, maintaininghealthy body exercise. The quot;cumulativeadvantagequot;hypoth- weight) and change their negative health esis (Ross and Wu 1996) directlyaddressesthe behaviors (e.g., smoking) at a slower rate than issue of time by positing that the longer an higher socioeconomic status individuals individual is exposed to a protective factor, (Berkman and Breslow 1983; Blaxter 1990; such socioeconomic advantage,the greaterthe National Center for Health Statistics 1998; health-related benefit. Scholars have found Piani and Schoenborn 1993; Ross and Wu some supportfor the cumulativehealth status 1995; Stroneggeret al. 1997; U.S. Department benefits of education(e.g., House et al. 1990; of Health and Human Services 1996). House et al. 1994; Ross and Wu 1996), howev- Evidence from different studies however sug- er this question has not yet been considered gests that differentindicatorsof socioeconom- with respectto participation regularphysical in ic status (e.g., education and earnings) may activity.Assuming that socioeconomic advan- have differentassociations with physical activ- tage provides cumulative benefits for contin- ity, and that these associations may differ by ued participation regularexercise over time, in gender (Cauley et al. 1991; Fordet al. 1991) or we hypothesizethat a wider gap in the benefits measure of physical activity (Cauley et al. of educationand earningswill be more appar- ent at older ages than younger ages. 1991). Three importantfeatures are demonstrated by the previous studies that supportthe mean- ingfulness of an ecological model in the study Contextualand IndividualCorrelatesof of physical activity. First, socioeconomic sta- Physical Activity tus is best conceptualized as being multidi- mensional, and each independent dimension Certainrecurring patternsin everydaysocial (e.g., education and income) has the ability to life exert a disproportionate amount of influ- influence physical activity habits in different ence on well-being (Stokols 1996) and, pre- ways. For example, educationmight influence sumably,on behaviors related to health. Most health behaviors though a greater ability to adults are nested within families, occupations, receive and interpretinformationregardingthe and communities; consequently, comprehen- health benefits of regular exercise. Earnings, sive models of physical activity need to con- on the other hand, independent of education, sider social and environmentalfactors from each of these domains or settings might promote physical activity throughaddi- tional discretionaryincome that allows pursu- (Bronfenbrenner 1979). Unfortunately,most ing physically active hobbies during leisure health behavior research does not give ade- time. Next, this researchhighlights the impor- quateattentionto notablecontextualor ecolog- tance of recognizing the specific type of phys- ical factorsthatmay supportor underminepar- ical activity being studied (e.g., amount of ticipationin regularphysical activity.However, leisure time physical activity per week versus researcherscan use middle-rangetheory and kilocalories expended per day). Finally,multi- empirical evidence from different fields (e.g., ple strands of evidence suggest that the link family studies, occupational health, urban between socioeconomic status and health is planning) to identify high-powered leverage gendered whereby education and earnings points (i.e., factors that exert, or potentially have consistent health effects among men but exert, a disproportionate amount of influence; not women (see Marmot et al. 1987; see Stokols 1996) for influencing exercise. McDonough et al. 1999). We hypothesize that Thefamily microsystem. The family is a pri- a higher level of education and a higher level mary life domain for most adults. Since indi- of earnings will be independentlyassociated viduals in specific family roles, such as spouse with more regular physical activity. We also or parent,are frequentlyfound to participatein hypothesize that the effects of education and fewer health-risk behaviors (Chilcoat and
  5. 5. 205 INEQUALITIES EXERCISE AND SOCIAL Breslau 1996; Horwitz and Raskin White Cooper 1993; Frone, Russell, and Cooper 1991; Umberson 1987), the family is believed 1997), suggesting that incompatiblework and to be an importantsource of social control of family responsibilitiesmay underminepositive behaviors related to health (Umberson 1987). health behaviors such as exercise (Backett Similarly, family life provides an important 1992; Backett and Davison 1995). However, general context for health promotingbehavior recent theory emphasizes the quality of fit (Doherty and McCubbin 1985; Pratt 1976; between work and family as opposed to expe- Walsh 1993). Previous research, for example, riences of strainsalone (Barnett1998). That is, has demonstrated that emotionally close fami- both the benefits (Sieber 1974) and the strains ly relationshipsand happy,stable, and satisfy- (Goode 1960) of role accumulationneed to be ing marriagespredictless healthrisk behaviors consideredwhen examiningthe health impacts among adults (Doherty and Harkaway 1990; of the work-family interface. Based upon Franks, Campbell, and Shields 1992; Pratt recent work-family theory (Barnett 1999; 1976; Wickrama et al. 1997a). Following Grzywacz and Marks 2000), we hypothesize that more positive spilloverbetween work and social controltheory,we hypothesizethatmar- ried individualsand parentswill exercise more family and less negative spillover between frequentlythan single or childless individuals. work and family will be associated with more Consistent with family systems theory, we regularphysical activity. hypothesize that individualsin an emotionally The researchcited here shares one common limitation. Assuming that specific health close family and an emotionally close mar- behaviors are reflections of a common latent riage will exercise more. The work microsystem.The workplace is a quot;lifestylequot; construct,researcherstypically use target for implementing health promotion summed indices of health-related behavior (e.g., non-smoking, non-problemalcohol use, interventions(PublicHealth Service 1991), yet and regular exercise) or substance use as the we lack a body of clearly defined research dependent variable. Consequently,it remains explicitly examiningthe impact and the mech- unclear what effect, if any, family, work, and anisms through which the workplace influ- work-familyspilloverwill have specifically on ences behavior related to health (for recent physical activity,since wellness enhancingand review see Eakin 1997). Nonetheless, a variety risk-taking behaviors (e.g., regular physical of job characteristics,particularlyhigh deci- activity versus substance use; Vickers, sion latitude,have been found to predict fewer Conway, and Hervig 1990) are qualitatively health-risk behaviors (House et al. 1986; different(for review, see Gochman 1997), and Mensch and Kandel 1988; Weidneret al. 1997; may not share the same contextual determi- Wickramaet al. 1997b). Based upon occupa- tional stress theory (House 1981; Karasekand nants. Community.A wide range of community Theorell 1990) and previous research, we characteristicsmay influence an individual's hypothesize that having more decision latitude ability to practice various behaviorsrelated to on the job will be associatedwith more regular health (Cheadle et al. 1999; Taylor, Repetti, physical activity.We also hypothesizethat due and Seeman 1997). Evidence from different to time constraints,a greaternumberof hours sources indicates that individuals who live in worked per week will be associated with less unsafe communitiesor neighborhoodsare less exercise. likely to engage in regular physical activity The work-family mesosystem. Ecological (Centersfor Disease Control 1999; Eyler et al. theory also contends that unique contributions 1998; Ross 1993; Sallis et al. 1997). Although to the overall context of human development some reportssuggest that neighborhoodsafety are derived from interactionsbetween two or serves as a physical barrierto regularactivity more life settings (i.e., mesosystems; throughfear of victimization (e.g., Centersfor 1979). Managingand integrat- Bronfenbrenner Disease Control 1999; Ross 1993), the mecha- ing work and family is an increasinglysignifi- nisms linking neighborhoodsafety to individ- cant task for adults today (Bielby 1992; ual physical activity have not been adequately Heckhausen1997; Lachmanand Boone-James tested or identified. We hypothesizethat living 1997). Work-familystrainhas been foundto be in neighborhoodscharacterizedas unsafe will associatedwith more alcohol use among adults be associatedwith less participationin regular (Bromet, Dew, and Parkinson 1990; Frone, Barnes, and Farrell 1994; Frone, Russell, and physical activity.
  6. 6. JOURNALOF HEALTHAND SOCIALBEHAVIOR 206 ProximalIndividualResources and Processes Physical Activity:An Ecological Perspective The ecological model of physical activity An individual'sphysical and psychological duringadulthoodthat guided this study is por- characteristicsare perhaps the most proximal trayed in Figure 1. Consistent with previous determinantsof physical activity. In our con- research, Figure 1 suggests that sociodemo- ceptualization, we include these factors as graphic characteristics, including multiple potential proximal processes conditioned by aspects of socioeconomic status, have direct more macrosociological processes, working effects on rates of participationin regular,vig- throughthe opportunities,constraints,and rel- orous exercise. Additionally, our model sug- ative stressors that are allocated through the gests that these sociodemographiccharacteris- social hierarchiesindicated by socioeconomic tics may also have indirecteffects on physical status, age, gender, and race (see Williams exercise by influencing the characteristicsof 1990). individuals' daily contexts (family, work, and Physiologically, progressive reductions in community)andthe interactions betweenthese maximal oxygen uptake(V02 max), cardiovas- contexts (work-family interface). We also cular function, and declining muscle mass expect thatthe qualityof these life settingswill through adulthood are believed to interfere shape more proximalindividualresources and with individuals'abilities to participatein reg- processes-including functionaland breathing ular or prolonged bouts of physical activity. limitations to physical activity, body mass However,studies clearly indicate that many of index, environmentalmastery,exercise effica- the physiological declines associated with cy (i.e., belief that exercise is a good way to aging are the result of, not the cause of, promotehealth) and control over health-that, reduced physical activity (see Goldberg, in turn,influence rates of participation exer- in Dengel, and Hagberg 1996). This evidence cise. suggests that the unfolding of social and psy- chological dynamics throughout adulthood cause reductions in physical activity (Backett METHOD and Davison 1995) that become progressively Data reinforcedby subsequentreductionsin physio- logical function. We hypothesize that a higher The data used for this study are from the body-mass index, more functional restrictions National Survey of Midlife Development in related to activity, and reduced lung capacity the United States, collected in 1995 by the will be associated with less regular vigorous John D. and Catherine T. MacArthur exercise. FoundationResearch Network on Successful Psychological theories and models that Midlife Development (N = 3,032; 1,471 men place primary attention on individual-level and 1,561 women). The originalpurposeof the beliefs, attitudes, and values (Glanz, Lewis, National Survey of Midlife Development was and Rimer 1997) typically guide health behav- to examine patterns, predictors, and conse- ior research.Individualprocesses such as more quences of midlife developmentin the areasof self-efficacy (Dzewaltowski 1994; Rosen- physical health, psychological well-being, and stock, Strecher,and Becker 1988), a belief that social responsibility.Respondentsare a nation- exercise is an efficient way to promotehealth, sample of non-institutional- ally representative and a greater sense of control over health ized persons aged 25-74 who have telephones. (Strickland 1978) have all been theorized and The samplewas obtainedthroughrandomdigit subsequentlyfound to influence physical activ- dialing, with an oversamplingof older respon- ity among adults (King et al. 1992; U.S. dents and men made to guaranteea good dis- Department of Health and Human Services tributionon the cross-classificationof age and 1996). We drawupon existing value-expectan- gender.Samplingweights correctingfor selec- cy theoriesto hypothesizethata higher level of tion probabilitiesand non-responseallow this self-efficacy, a greaterbelief in the healthben- sample to match the composition of the U.S. efits of exercise, and more perceived control populationon age, sex, race, and education. over health will be associated with more fre- Respondents first participated in a tele- quent participationin regularphysical activity. phone interviewlasting approximately min- 40
  7. 7. 207 INEQUALITIES EXERCISE AND SOCIAL FIGURE 1. An Ecological Model for Regular Vigorous Physical Activity during Adulthood utes. The response rate for the telephone ques- seasonal effects (Marmot et al. 1991). tionnaire was 70 percent. Respondentsto the Specifically, respondents were asked: (1) telephone survey were then asked to complete quot;Duringthe summer,how often do you engage two self-administered mailback question- in vigorousphysical activity(for example,run- naires. The response rate for the mailback ning or lifting heavy objects) long enough to questionnaire was 86.8 percent of telephone work up a sweat?quot;and (2) quot;Duringthe winter, respondents.This yielded an overall response how often do you engage in vigorous physical rate of 60.8 percentfor both partsof the survey activity long enough to work up a sweat?quot; (for a detailed technical reportregardingfield Response categories included several times a procedures,response rates, and weighting, see week or more (6), about once a week (5), sev- times a month (4), aboutonce a month (3), less than once a month (2), or never (1). The #tchrpt). two items were highly correlated (r = .89); consequently, we used the mean of the two items to assess regular,vigorous exercise. (See Measures:Dependent Variable Table 1 for descriptivestatistics for all analyt- even a small amountof exercise is ic variables.) Although better than being sedentary (e.g., Kunst et al. 1999; Dunn et al. 1999; U. S. Departmentof Health and Human Services 1996), evidence Measures: IndependentVariables indicatesthatregularexercise in 60-90 percent Social status. Age was included as a contin- of an individual'stargetheartrate is most ben- eficial to overall health (American College of uous variable in these analyses. Gender (1 = Sports Medicine 1990). Therefore, we con- female) and race/ethnicity (1 = black) were structeda continuousoutcome measureof reg- included as dichotomousmeasures. Education ular vigorous exercise using two previously representsthe numberof years of formal edu- validated measures (Blair 1984; Kohl et al. cation completed and is coded as an ordinal 1988; Washburn al. 1990) adaptedto include variable as follows: 1 = 1-6 years, 2 = 7-8 et
  8. 8. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 208 TABLE 1. Descriptive statistics for all analysis variables SD M Range Dependent Variable 1.75 4.04 1-6 Regular,Vigorous Exercise Social Status Characteristics 45.30 13.48 25-74 Age Gender(female = 1) 56.6% Race/Ethnicity(black = 1) 11.2% 2.41 6.20 1-12 EducationalAttainment Household Earnings 0-300,000 36,172 39,254 Family & WorkMicrosystems ParentalStatus(Child < 18 = 1) 41.1% MaritalStatus (not married- 1) 31.9% 37.3% High Spouse Emotional Support 30.4% Low Spouse Emotional Support .63 3.41 1-4 FamilyEmotional Support CurrentlyWorkingFor Pay (Yes = 1) 73.8% 43.52 15.53 1-168 HoursWorkedper Weeka .87 1-5 3.62 Decision Latitudeat Worka Spillover between Work Familya & .74 1-5 2.62 Negative Workto Family .84 1-5 2.62 Positive Workto Family 2.11 .68 1-5 Negative Familyto Work 1-5 .84 3.41 Positive Familyto Work Environment Community 3.36 .56 1-4 NeighborhoodSafety IndividualProximalProcesses/Resources 9.44-64.02 5.65 26.80 Body Mass Index 1-4 .77 FunctionalRestrictionsfrom Exercise 1.44 0-3 .57 .18 Shortnessof Breathwhen Active 3-21 3.42 15.87 Environmental Mastery 1-6 .77 PerceivedControlover Health 5.36 0-4 Efficacy of Exercise 3.68 .85 Source: National Surveyof Midlife Developmentin the UnitedStates 1995. Notes: Estimatesare based on weighted data. aEstimateobtainedfrom only respondentswho were working for pay when they completed the questionaire. years, 3 = 9-12 years but no diploma or GED, categories to facilitate inclusion of all respon- 4 = GED, 5 = graduated from high school, 6 = dents:(1) Individualswho were unmarried, (2) 1-2 years of college but no degree yet, 7 = 3 or married individuals with a mean response of more years of college but no degree yet, 8 = less than4 (i.e., low emotionalsupport;used as graduatedfrom a two-yearcollege or vocation- the contrastcategory),and (3) marriedindivid- al school, or associate's degree, 9 = graduated uals with a mean response of 4 (i.e., high emo- from a four- or five-year college, or bachelor's tional support;note: 56.4% of marriedrespon- degree, 10 = some graduate school, 11 = mas- dents had a mean of 4 for spouse emotional ter's degree, and 12 = doctoralor otherprofes- support;consequently,we chose this value for sional degree. Household earningswere coded maximal variability in the measure). Family continuouslyin thousandsof dollars. emotional supportmeasuredthe level of emo- Family Characteristics. Spouse emotional tional supportprovidedto the respondentfrom support measured the level of emotional sup- his or her other family memberswith a paral- lel 4-item index (a = .83) that was included in port providedto the respondentfrom his other spouse using the mean of a 6-item index (a = the model as a continuous measure. Parental status (i.e., has a child under 18 years old = 1) .85) adapted from Schuster, Kessler, and Aseltine (1990) (e.g., quot;How much does your was also included in our model. spouse or partner really care about you?quot; Work characteristics.Decision latitude was quot;Howmuch can you rely on him or her for help assessed by summing responses to five items if you have a serious problem?quot;). Response measuringthe amountof controlthe individual categories for the index items were not at all has over his or her work environment and (1), a little (2), some (3), and a lot (4). Spouse tasks, and the specialization of labor (e.g., emotional supportwas then divided into three quot;How often do you have a choice in deciding
  9. 9. 209 AND EXERCISE SOCIAL INEQUALITIES how you do your tasks at work? How often do egories were not at all (1), some (2), a little (3), you have a choice in deciding what tasks you and a lot (4). Reduced VO2 max was opera- do at workquot;;a = .87). We also includeda mea- tionalized using three items adaptedfrom the sure of the number of hours the respondent Rose Questionnaire for angina (Rose et al. reportedworking(i.e., sum of responsesto two 1982) assessing if respondents get short of questions regardinghours worked last week in breath (yes/no) while (1) quot;walkingwith other primaryand additionaljobs). people your age on level ground;quot; quot;walking (2) at your own pace on level ground;quot;and (3) Work-familyspillover. Negative spillover quot;washing or dressingquot; (a = .74). Body mass from worktofamily measuredthe respondent's perception of the extent to which work inter- index was computed using the Quetlet Index fered with functioningat home by calculating (i.e., weight/height2). the mean response to four items (e.g., quot;How Control over health was measured using often does stress at work make you irritableat three items adaptedfrom the WhitehallSurvey home?quot;; a = .84). Conversely, positive (Marmot et al. 1991), including 1) quot;Keeping spillover from work to family assessed the healthy depends on things that I can do;quot; (2) extent to which the respondent felt that their quot;Thereare certainthings I can do for myself to work promoted better functioning at home reducethe risk of heartattack;quot; (3) quot;There and (e.g., quot;How often do the things you do at work are certainthings I can do for myself to reduce help you deal with personal and practical the risk of getting cancer.quot; Response categories issues at home?quot;;a = .74). Negative spillover for the control over health items ranged from from family to work assessed the extent to strongly disagree (1) to strongly agree (6) (a which the respondentfelt their family life was =.71). interferingwith their success on the job (e.g., Environmentalmastery is a component of quot;How often does stress at home make you irri- psychological well-being that assesses an indi- table at work?quot;; a = .81). Finally, positive vidual's sense of mastery and competence in spillover from family to work measured the managing the surroundingenvironment(Ryff extent to which respondents felt their family 1989). Environmentalmastery was measured life helped them perform better on the job with three items: (1) quot;In general, I feel I am in (e.g., quot;How often does talkingwith someone at charge of the situation in which I live;quot; (2) home help you deal with problems at work?quot;; quot;The demands of everyday life often get me a = .73). Response categories ranged from down;quot;and (3) quot;I am quite good at managing never (1) to all the time (5). The work-family the many responsibilities of my daily life.quot; Response categories for the environmental spillover items were developed for the National Survey of Midlife Development in mastery items ranged from strongly disagree (1) to strongly agree (7) (a = .52). Although the United States. the estimated reliability of the environmental Community. Perceived community safety mastery scale used in the National Survey of was measuredwith the mean response to four Midlife Development in the United States is items developed for the National Survey of modest, previous research has indicated that Midlife Development in the United States: (1) the three-item measure is strongly correlated quot;I feel safe being out alone in my neighbor- with its highly reliable parent measure (Ryff hood during the daytime;quot; (2) quot;I feel safe being out alone in my neighborhoodat night;quot; and Keyes 1995). Exercise efficacy assessed the extent to (3) quot;I could call on a neighbor for help if I which respondents believe that exercise is a needed it;quot; and (4) quot;People in my neighbor- beneficial and preferred way of promoting Response categoriesfor hood trusteach other.quot; health. Respondentswere asked to respond to the communitysafety items rangedfrom not at all (1) to a lot (4) (a = .65). a hypothetical scenario during the telephone interview quot;Assume for a moment that your Physiological and psychological resources doctor said you had a heart condition and said andprocesses. Functional restrictionsto phys- you could choose either to have coronary ical activity was assessed with a 4-item scale bypass surgeryor exercise at least three times revised from the Medical Outcomes Study a week for at least half an hour each time. (Brazier et al. 1992) asking how much the Which one do you think you would choose?quot; respondent's health limited walking several Respondentswere then asked, quot;How sure are blocks, walking one block, vigorous activity, you that this is what you would choose?quot; very and moderateactivity (a = .92). Response cat-
  10. 10. 210 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR pay when they completedthe telephone survey (1), somewhat (2), or not very sure (3). Being and self-administered questionnaires;conse- very sure about choosing exercise was coded 3, quently, some individuals were legitimately being somewhat sure about exercise was coded 2, being not very sure about exercise was on quot;decision hours latitude,quot; quot;missingquot; worked/week, and each of the work-family coded 1, and choosing bypass surgery was spillover measures. Rather than limiting the coded 0. sample to employedadults only, we includeda quot;missing flagquot; indicator variable for each measurein the model to generate work-related Analytic Sequence more reliable population parameterestimates (Orme and Reis 1991). To assess our first hypotheses regarding the Unweighted results are reported since fac- independent effects of various social status tors used in over-samplingwere controlled in factors, we began by regressing our physical all analyses and the overallpatternof findings activity outcome on age, gender, race, educa- were similar for both weighted and unweight- tion, and earnings. Then, to consider how age ed analyses (Winshipand Radbill 1994). and gender might condition the effect of edu- cation and earnings we added interaction terms for gender X education, gender X earnings, RESULTS age X education, age X earnings, age X gender X education, and age X gender X earnings Social Status and VigorousPhysical Activity interaction terms to the model (to avoid collinearity problems, we used age, education, Table 2 reports the results of five models and earnings centered on the mean in the estimatingthe impact of social status, contex- analyses and in the construction of the interac- tual characteristics,and personal characteris- tion terms; Cronbach 1987). Unfortunately, the tics on regular,vigorous exercise. Consistent black sample was not large enough to allow for with previous reports (e.g., U. S. Department a consideration of higher order race interac- of Health and Human Services 1996), the first tions. Change in R2 was used to assess if the model in Table 2 indicates that younger indi- addition of the interaction terms significantly viduals, men, non-blacks, those with more contributed to the explanatory model (Jaccard, education, and those with higher household Turrisi, and Wan 1990). We then proceeded to earnings participatein more regular physical add blocks of contextual experiences and indi- activity.However,Model 2 furtherreveals that vidual-level characteristics to the social status the effects of earningson physical activity dif- model and evaluated the corresponding fer by genderandthatthe educationeffects dif- changes in the association between social sta- fer by age and gender. Figure 2 plots the sig- tus and physical activity. nificant gender X earnings interaction and Not all of the respondents were working for TABLE 2. OLS Estimates of the Association between Social Status, Contextual Experiences, Individual Resources and Processes, and Regular Vigorous Exercise Model 1 Model 2 Model 3 Model 4 Model 5 -.033*** -.029*** -.025*** -.029*** -.023*** Agea (.003) (.002) (.004) (.004) (.004) Gender(female = 1) -.741*** -.758*** -.708*** -.688*** -.628*** (.063) (.063) (.065) (.065) (.062) Race/ethnicity(black = 1) -.356** -.336** -.353** -.285 -.162 (.133) (.133) (.132) (.132) (.126) Educationa .057*** .022 .022 .022 -.006 (.013) (.018) (.018) (.018) (.017) Household Earnings(thousands)a .003** .001 .0002 .0002 -.0003 (.001) (.001) (.001) (.001) (.001) GenderX Agea -.007 -.009+ -.007 -.005 (.005) (.005) (.005) (.005) GenderX Educationa .034 .065 .053* .046+ (.027) (.027) (.027) (.025) GenderX Earningsa .003+ .004* .004* .003+ (.002) (.002) (.002) (.002)
  11. 11. 211 AND EXERCISE SOCIALINEQUALITIES TABLE 2. (Continued) Model 1 Model 2 Model 3 Model 4 Model 5 Agea X Educationa .003** .003* .003** .003* (.001) (.001) (.001) (.001) GenderX Agea X Educationa -.005* -.005* -.005 -.004* (.002) (.002) (.002) (.002) Family & Work Microsystems ParentalStatus (Child < 18 = 1) .074 .051 .040 .077 .077 .073 .187* Not CurrentlyMarriedb .189* .215** (.084) (.083) (.080) High Spouse EmotionalSupportb .185* .118 .089 (.079) (.081) (.078) FamilyEmotional Support .120* .024 -.036 (.052) (.053) (.051) Decision Latitudeat Workc .105** .041 .040 (.038) (.043) (.041) HoursWorked/Week .004+ .006* .006* (.002) (.003) (.002) Mesosystemc& CommunityEnvironment Work-Family Negative SpilloverWorkto Family -.160** -.062 (.061) (.059) Positive SpilloverWorkto Family .144** .131** (.049) (.046) Negative Spillover Familyto Work .046 .093 (.065) (.068) Positive SpilloverFamilyto Work .055 .032 (.047) (.045) .351*** .268*** NeighborhoodSafety (.059) (.061) IndividualProximalProcesses FunctionalRestrictions -.570*** (.049) Shortnessof Breath -.177** (.062) Body Mass Index -.013* (.006) .019* Environmental Mastery (.010) PerceivedControlover Health .071+ (.042) .099** Exercise Efficacy (.036) 2.48*** 2.79*** 4.52 3.40*** Constant 4.50*** .447 .045 .351 .045 .247 .253 .172 .143 .153 AdjustedR2 .138 .022*** .082*** .007*** .012*** n/a AR2 +p <.10; * p <.05; **p < .01; ***p <.001 (two-tailed) Source: National Surveyof MidlifeDevelopmentin the United States, 1995. Note: Numbers in parenthesesare standarderrors.Estimatesare based on unweighteddata. have been centeredon the mean to avoid collinearityproblems. aVariables bIncontrastto marriedindividualswith low emotional support. variableswere also only relevantto employed individuals.Missing indicatorflag variablesfor work-related CEstimates included in models 3-5. activity across adulthood are the direction of indicatesthat a higher level of household earn- the association in early adulthoodand the rate ings is associated with more vigorous exercise of decline with age. In contrastto the frequent- among women but not men. ly reportedpositive association between more To interpretthe significant three-way gen- physical activity and higher education, these der X age X education interactioneffect, we results indicate that men with the lowest level plotted the predicted mean levels of regular of educationhave the highest level of regular, exercise by age, education, and gender (see vigorous exercise during young adulthood, Figure 3). The most salient education differ- while the most educated men exercise least ences between men and women in physical
  12. 12. 212 JOURNALOF HEALTHAND SOCIALBEHAVIOR Earningsand Gender FIGURE2. Vigorous Exerciseby Household 4.8 - 4.6 - .) 4.4 - 4.2 - 0 4- Men -I0 o _-U-W omen 3.8 - o ._ > w 3.6 - 3.4 - 3.2 3 I I I -1 S.D. Household +1 S.D. Household Mean Household Earnings Earnings Earnings during the younger years. However, the age- earnings does not accumulate with age (con- related decline in vigorous exercise is steepest traryto our cumulativeadvantagehypothesis). among the least educatedmen and most grad- It is also noteworthythat blacks reportedsig- ual for the best educated. This leads to age- nificantly less vigorous physical exercise than related trajectoriesin physical activity among non-blacks,even controlling for major dimen- men that converge in midlife (i.e., 50-55) and sions of socioeconomic status. then proceed to provide an advantagein phys- ical activity during later adulthood to those with the highest education.By contrast,among ContextualCharacteristicsand Regular women, having a high level of education is Physical Activity associated with more vigorous exercise in Results reported in Table 2, Model 3 also young adulthood,but this benefit is attenuated indicate contextualfactors from multiple con- in later adulthood. Counter to the cumulative texts, and multiplelevels are notablecorrelates advantagehypothesis, the slope of age-related decline in exercise among women is the least of regularphysical activity.In contrastto indi- viduals in marriages characterizedby a low steep for those with the lowest level of educa- tion and greatest among those with the highest level of spouse emotional support,single indi- level of education.The age X earnings,and the viduals and individuals with a high level of gender X age X earningsinteractionterms did spouse emotional supportparticipatein more not contribute to the model in preliminary vigorous exercise. Also consistent with our analyses, so they are not included in Model 2. family systems-basedhypothesis, we find that Collectively this evidence provides mixed a higher level of family emotional supportwas support for our social status hypotheses. also independentlyassociated with more regu- Consistent with the cumulative advantage lar exercise. Paralleling other reports using hypothesis and our hypothesisanticipatingthat health behaviorscales as outcomes, our results socioeconomic advantage would be most also indicatethat a higher level of decision lat- applicableto men, we find that advancededu- itude among currently employed respondents cation contributesto a slower decline in physi- was associated with more regular, vigorous cal activity among men than women. However, exercise. Contrary our hypothesis,trendevi- to contraryto the cumulativeadvantagehypothe- dence indicate that working more hours was sis, women with a college education have a associated with more regular exercise. steeper decline than women with less educa- Collectively,these results supportthe ecologi- tion. Additionally,a higher level of household cal perspective suggesting that factors from earnings appearsto promote regular,vigorous multiple contexts of daily life influence behav- exercise among women only (contraryto our ior and development. gender hypothesis), and the benefit of higher Higher ordercontextualfactors, such as the
  13. 13. 213 AND EXERCISE SOCIALINEQUALITIES Exerciseby GenderandAge FIGURE3. Education Vigorous in Men 6.00 - 5.50 - e 5.00 - >1fifo C 4.50 - o o 4.00 - >3.50 - 3.00 I I I I I I I I I I I 75 25 30 35 40 60 70 45 50 55 65 Age Women - -< High School 5.50 - School --High ) 5.00 - 3 Yrs College iquot; College Grad 4.50 - 4.00 O 4.00 - > 3.50 - 3.00 I I I I I I I I I I I 25 30 35 40 45 50 55 60 65 70 75 Age Source: National Survey of Midlife Development in the United States, 1995 quality of fit between work and family and the family interface completely explained the community environment, are also important association between family and spouse emo- correlates of physical activity among adults. tional supportand physical activity.That is, a Table2, Model 4 indicatesthata lower level of higher level of family and spouse emotional negative spillover from work to family and a support is associated with more positive and higher level of positive spillover from work to less negative spillover from work to family, family is associated with more regular exer- which in turn is associated with more healthy activity habits. Moreover,once the quality of cise. Additional analyses (not shown) further the work-family fit was controlled in the indicated that these dimensions of the work-
  14. 14. 214 JOURNALOF HEALTHAND SOCIALBEHAVIOR model, we find that working more, ratherthan family appearsto be indirectlyassociatedwith fewer, hours per week was associated with lower physical activity throughits association more regularexercise. Finally, consistent with with a lower level of environmental mastery. our hypothesis, analyses indicatedthat respon- dents who perceived their neighborhoods as more safe participatedin more regular,vigor- DISCUSSION, SUMMARY, AND CONCLUSIONS ous exercise than individualsin less safe com- munities. Moreover,neighborhoodsafety part- The overall goal of this study was to use ly explains the race/ethnicity effect; that is, blacks are less likely than non-blacksto report ecological theory to systematically examine the complex associations between multiple living in a safe neighborhood,and,in turn,par- social status characteristicsand participation ticipate in less regularphysical activity. in regular,vigorous exercise. We also wanted to explore the degree to which everyday con- ProximalResources & Processes and Regular textual factors in family, work, and communi- ty, as well as more proximal individual Physical Activity resourcesandprocesses might help accountfor Building from ecological theory,we expect- and also uniquely contributeto differences in ed that important individual resources and exercise behaviorduringadulthood. processes would be independentlyassociated Results from this study replicateand extend with physical activity and might also partially previous research in several importantways. account for the associations between social First,with regardto socioeconomic status, our status and contextualexperiences and exercise descriptivefindings replicateothers indicating behavior (see Table 2, Model 5). Consistent that higher levels of earnings and education with a largebody of previousresearch,we find were both independentlyassociated with more that physiological declines, including exercise among some populationsubgroupsof increased body mass index, physical activity adults. Consistent with some conceptualiza- limitations due to functional impairment,and tions of social inequality,these results suggest shortness of breath associated with physical thathealthpractitioners need to recognizemul- activity are associated with less participation dimensions of socioeconomic position tiple in regular exercise. Similarly, consistent with when formulatingand implementingstrategies our hypotheses guided by value-expectancy to eliminate health inequalities. If socioeco- theories of health behavior, we find that nomic status is viewed in terms of education greater environmental mastery (a proxy for alone, interventions targeting income-related self-efficacy), more perceived control over determinantsof physical activity will remain health (trend), and a higher level of exercise unrecognizedor under-prioritized. efficacy were associated with more regular Equally important however are our new results indicating that age and gender condi- physical activity. The persistent race/ethnicity effect evi- tion associations between educationand regu- denced in all previous models is completely lar exercise. This patternof results is notewor- explained in the full biopsychosocial model of thy for several reasons. First, since the slope exercise (i.e., Table 2, Model 5). African between educationand the rate of participation Americansreportedhigherlevels of body mass in vigorous exercise is different depending index, more functional limitations related to upon age and gender (Krieger et al. 1997), activity, and greater shortness of breath than these results raise caution regardingthe unex- whites, and this accounted for the remaining amined inclusion of educationmerely as a lin- exercise differences between blacks and non- ear covariate in studies of physical activity. blacks. Likewise, educational differences in These resultsalso suggest thattargetsfor phys- physical activity among women were com- ical activity interventionsmay need to change pletely explained by these individual-level dependingupon the age, gender,and education resources.Womenwith a bettereducationwere of the target population. For example, inter- in better physical condition, and had a higher ventions targetingpoorly educatedyoung men level of each of the psychological resources may need to focus on maintaining physical conducive to healthy exercise habits. Finally,a activity habits, while interventions targeting higher level of negative spillover from work to poorly educated young women may need to
  15. 15. 215 SOCIAL INEQUALITIES EXERCISE AND thatprovidethe flexibility,opportunity, the focus on initiating exercise habits. Finally, and expectation of regular physical activity (e.g., these results again remindscholarsthat survey questions about physical activity may tap dif- golf outings with clients, on-site fitness facili- ferent meanings for different groups of indi- ties, company sponsoredgym memberships). viduals. That is, it is possible that the counter- The contextual effects found in this study intuitiveeducation-exerciseassociationamong extend previous health behavior research. young men is capturing occupation-based First,in contrastto several studies using health behavior indices, this study found that differ- physical activity that may yield less notable health gains than regular aerobic-forms of ent aspects of work and family were specifi- exercise, which may have more health bene- cally associatedwith physical activity.Perhaps fits. even more importantly,however, this study We also think that the explanatorypower of demonstrated how overlookedaspects of work the social status model is worthy of attention. and family may influence different health- Although our final model only accounted for relatedbehaviors.For example, the work-fam- 25 percentof the variancein vigorous exercise, ily literaturehas been dominated by studies social status factors provided most of the exploring the effects of work-family conflict explanatorypower (i.e., 14 percent). Consis- (Barnett 1998), and this research frequently tent with an ecological perspective, this finds that work-family conflict is associated evidence suggests that models that integrate with behaviors and conditions (e.g., alcohol theory and concepts from across disciplines abuse and depression; Frone, Russell and Cooper 1997) that undermineregularexercise (e.g., social status and behavioral intention) will generate more comprehensive explana- (King et al. 1992). However, the evidence tions for behaviorand may facilitatemore suc- reportedin this study indicate that more posi- cessful interventionsto change behavior. tive spilloverfromworkto family (a dimension not typically considered) has the most robust It is also interestingto note that contextual association with greater frequency of regular experiences and physiological resources explained education-level differences in exer- physical activity. The pattern of findings surrounding cise among youngerwomen. These resultspar- race/ethnicityin these models is also an impor- tially supportthe hypothesis that social status The conditions the resources and experiences that tant contributionto the exercise literature. fact that blacks were consistently found to facilitate participationin positive health-relat- exercise less than non-blacks, independentof ed behaviors (e.g., Ross and Wu 1995). This education and earnings, suggests that race is everyday interactional perspective of the not an adequateproxy for socioeconomic sta- socioeconomic statusand healthbehaviorrela- tus, and thatotherfactorspertainingto race are tion is markedly different from assumptions contributingto differences in physical activity regarding the absence of important health patterns. Consistent with a recent biopsy- related benefits of exercise (e.g., the Health chosocial model of racism as a stressor(Clark Behavior Model) that may accompanyhigher et al. 1999), our results suggest that contextual levels of education. Although the pattern of factors from the social environment such as results for education among men supportsthe neighborhoodsafety may directlyand indirect- cumulative advantage hypothesis and theory ly undermineexercise habits. Inadequatestreet suggesting that the health effects of socioeco- lighting at a modest level or witnessing violent nomic status are gendered (Marmot et al. crime in your neighborhood at an extreme 1987; McDonough et al. 1999), none of the level are direct physical barriers to outdoor contextual experiences or individual-level regular,vigorous activity, while the threat of resources could explain men's educationaltra- victimization (e.g., Ross 1993) and compro- jectories across adulthood.Perhapsthe persis- mised feelings of masteryor controlare impor- tent educationeffect among men can be attrib- tantpsychological barriers.These physical and uted to the confounded nature of physical psychological barriersto physical activity may activity in men's occupations(see Eakin 1997). set into motion reductionsin physical activity That is, men who have a low education may habitswhich become furtherreinforcedby cor- find themselves in working-class jobs that responding reductions in physiological func- become less physically demanding as they tioning and ultimately undermine health. spend more time on the job, while men with Althoughthese linkages are supportedtheoret- more education may work their way into jobs
  16. 16. 216 JOURNALOF HEALTHAND SOCIALBEHAVIOR ically (Clark et al. 1999), we could not evalu- study may be due to common methodvariance ate these causal pathways with the current or endogeneity.Additionally,a more stringent cross-sectional data. operationalizationof ecological theory would We also feel the persistence of the robust require measures from additional levels and age effect on exercise should not go unno- sources (e.g., self-report of decision latitude ticed. Overall, in these data about 32 percent supplementedby a rating of decision latitude of respondents aged 25-35 indicated they for a respondent's occupational category). participated in vigorous exercise several Moreover,a comprehensiveecological model, times a week or more, while 28 percent of informed by other middle range theories, those 45-54, and 18 percent of those aged might furtherinclude a myriadof other possi- 65-74 did. After adjusting for so many con- ble interactions. textual and individual factors, including Nonetheless, our results supportthe value of declines in physiological capacity, we might employing an ecological perspective when have expected this effect to diminish more attemptingto understandhealth behavior.We substantially. find that, indeed, different aspects of social In an attemptto furtherunpack the persis- status were independently associated with tent age effect in these analyses,we rana series exercise, and that the influence of some status of post-hoc analyses including two- and three- factors variedby gender and age. We also find way interactions terms between age, gender, that contextualexperiencesin family and work and the contextual correlates. Only one of all life, the quality of the work-family interface, the possible interactionterms emerged signifi- and the community environment were all cant; paralleling other reports (Potts et al. directly or indirectly associated with exercise 1992; Rakowski et al. 1987; Zimmermanand habits and added significantly to the explana- Connor 1989), the two-way interaction tory power of our model. In short, our results between age and family emotional supportwas supporta biopsychosocialperspectiveof phys- significant (p < .05), suggesting that family ical activity duringadulthood,and they suggest supportwas associatedwith more regularexer- that future health behavior research needs to cise among older adultsthanyoungeradults.In consider determinantsfrom multiple contexts all the post-hoc models we examined,the neg- and multiple levels of the humanecology. ative associationbetween age and exercise per- sisted. What other experiences underminepar- ticipation in regularexercise as adults traverse REFERENCES the life course? We acknowledge the limits of these cross- Albert, Steven M. 1995. quot;New Perspectiveson the sectional data when interpretingage-effects in Elderly: Epidemiology and Public Health.quot; our analyses. That is we cannot differentiate CurrentIssues in Public Health 1:77-81. true quot;agequot;(i.e., developmental)from quot;cohortquot; American College of Sports Medicine. 1990. quot;The or quot;periodquot; effects. For example, the oldest RecommendedQuantityand Qualityof Exercise group in this sample would have been at the for and Developing Maintaining height of midlife when the Surgeon General Cardiorespiratory and Muscular Fitness in announcedthe first Healthy People objectives HealthyAdults.quot;Medicine and Science in Sports in 1979. Since original messages about exer- and Exercise 22:265-74. cise during this period targeted reducing car- Backett, Kathryn. 1992. quot;The Construction of HealthKnowledge MiddleClass Families.quot; in diovasculardisease (particularlyamong men), Health Education Research: Theory and it might be that highly educated young and Practice 7:497-507. middle-aged men from these cohorts respond- Backett, Kathryn C. and Charlie Davison. 1995. ed to such social marketingand this is reflect- quot;Lifecourse and Lifestyle: The Social and ed in contemporaryage-relatedphysical activ- CulturalLocation of Health Behaviours.quot;Social ity patterns. Not all birth cohorts might be Science and Medicine 40:629-38. expected to reportthe same levels of physical Barett, Rosalind C. 1998. quot;Towarda Review and activity at young and old ages. Reconceptualization of the Work/Family Considerationof these results must also be Literature.quot; Genetic, Social & General temperedby additionallimitationsof the study. Psychology Monographs124:125-82. For example, the data were all self-reported; . 1999. quot;A New Work-Life Model for the consequently,some of the associations in this Annals of the American Twenty-FirstCentury.quot;
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